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Oklahoma may have used the wrong drug during an execution…After Oklahoma executed Charles Warner…an autopsy report said that his body and containers for lethal-injection drugs were delivered to the state’s Office of the Chief Medical Examiner. Among those containers were empty vials labeled potassium acetate, even though the state’s lethal-injection protocol calls for the use of potassium chloride…potassium acetate and potassium chloride are "medically interchangeable."...The two different types of potassium appear to be equal, said David Gortler, an associate professor of pharmacology…"Potassium is potassium," Gortler said..."The pharmacology isn’t that much different between the different salts."

Centers for Medicare and Medicaid Services and ONC have released final rules for the EHR Incentive Programs, which they say will ease reporting requirements for providers and allow for 90-day reporting periods…also announced major news on Stage 3 of the program…CMS made some…big changes to the regulations:

• Give providers and state Medicaid agencies 27 months, until Jan. 1, 2018, to comply with the new requirements and prepare for the next set of system improvements.
• Give developers more time to create the next advancements in technology that CMS says will be easier to use and more appropriate to new models of care and access to data by consumers.
• Support provider exchange of health information and interoperable infrastructure for data exchange between providers and with patients.
• Address health information blocking and interoperability between providers.

Nevada Division of Insurance has posted 2016 health insurance rates for individual and small group markets online at http://healthrates.doi.nv.gov/Wizard.aspx,...This is the first opportunity for Nevadans who purchase health insurance on their own or as a small business to see how much it will cost in 2016. Open enrollment begins Nov. 1…

…changeover to ICD-10 medical diagnosis codes could complicate tasks in emergency departments…researchers...looked at more than 24,000 clinical encounters in the emergency room, they found that nearly a quarter could be assigned incorrect ICD-10 codes…also…27% of 1830 ICD-9 indicator codes commonly used by emergency physicians had convoluted mappings to ICD-10 codes that could pose problems for clinical documentation, reimbursement, disease reporting, and justifying hospital admissions…Depending on the analytic programs that the pharmacies use to predict how much medications to store and how complex the transition to ICD-10 is, pharmacies might have shortages of medications due to inaccurate reports and algorithms..

..Florida Board of Pharmacy approved a rule change…aimed at training pharmacists to change their mindset about prescriptions for controlled substances, in a reaction that followed pleas from desperate patients unable to get pain medications…change switches the rule from a focus on reasons to reject prescriptions for highly addictive narcotics to an emphasis on ensuring that legitimate patients get the medications…"Instead of starting out with trying to find a reason to doubt a prescription, you start off with an assumption that everything in the prescription is good…rule also includes requiring pharmacists to take a two-hour, "Validation of Prescriptions for Controlled Substances" course to educate pharmacists about ensuring access to pain medications for "all patients with a valid prescription."

...cleanup of the former American Cyanamid drug manufacturing site in Bridgewater, NJ, has been ongoing for decades. But the EPA this week presented Pfizer with a bill for its share of the cost of cleaning up the superfund site…Justice Department said that the drugmaker has agreed to pay $194 million for the cleanup of 6 disposal areas at the 575-acre site. It will chip in an additional $1 million to reimburse the EPA for costs the agency has already paid out for overseeing cleanup work at the 100-year-old site.

Centers for Medicaid & Medicare Services just released data on 2016's Medicare Part D plans…analysis reveals that 85% of Medicare Part D regional prescription drug plans will have a preferred cost sharing network in 2016…Preferred network plans are controversial (and generally disliked) by pharmacy owners. That’s because reduced pharmacy profits are the biggest source of cost savings from these networks. Despite ongoing complaints, it's still full speed ahead for preferred networks.

Department of Health and Human Services has issued the long-awaited final rules changing the requirements of the Meaningful Use program for 2015-2017 and implementing Stage 3 of the program…[s]hift the paradigm so health IT becomes a tool for care improvement, not an end in itself,"…rule eases the reporting burdens, simplifies requirements, adds flexibility, supports interoperability and improves outcomes. It also transitions to a new and more responsive regulatory framework…moves physicians out of the Meaningful Use program into a new merit based incentive payment system..

Some of the changes include:

• Providers and state Medicaid agencies will now have until Jan. 1, 2018, to comply and prepare for the next set of system improvements
• Stage 3 will now be optional in 2017
• Stage 3 will have eight objectives; more than 60 percent require interoperability; public health reporting with have flexibility options
• APIs will be required
• Cybersecurity requirements have been strengthened
• The reporting period for 2015 will be only 90 days for all providers, for new providers in 2016 and 2017 and for any provider moving to Stage 3 of the program in 2017

ICD-10 go live date came and went...with many organizations reporting small, if any, hiccups. One of those...was Beth Israel Deaconess Medical Center…with CIO John Halamka,.. reporting on his team's first few days…other than a few small refinements, the impact has been unnoticeable…financial system is able to process both ICD-9 and ICD-10 to support patients who were admitted on 9/30 and discharged on 10/1…scorecard listed only five minor issues...which our local teams…were able to…quickly close…thanks to all involved in this extremely smooth go live…Our next steps will be monitoring the coding of the initial inpatient cases and payer submissions along with watching reimbursements over the next 60 days.

Senator Lamar Alexander…called on the government to delay Stage 3 final rules – and offered five reasons why…"The whole purpose of this program is to benefit patients, so that they and their health care providers have quicker and better access to their health histories and their doctors and hospitals and pharmacists can provide them with better care,"…"There is no reason not to take time to do it right."

1. Stage 2 is so onerous, in fact, that just 12 percent of physicians and 40 percent of hospitals have managed to successfully attest.
2. Penalties and bonus payouts under the new Medicare payment system are inextricably tied with meaningful use compliance.
3. Many leading medical institutions with the best electronic health records systems also recommend proceeding with caution.
4. A recent GAO report that shows that, in many cases, MU mandates are actually hindering electronic health record interoperability.
5. The HELP Committee has worked to develop seven areas for legislation to drive interoperability:

• Decreasing unnecessary physician documentation;
• Enabling patients to have easier access to their own health records;
• Making electronic health records more accessible to the entire health care team, such as nurses;
• Stopping information blocking
• Ensuring that EHR certification "means what it says it does"
• Improving standards
• Ensuring the security and privacy of patient records.